Value-Based Designs Are a Solid Investment Even in a Slow Economy

San Diego—Value-based design insurance programs have remained a viable investment strategy even during the latest economic downturn, according to the results of a recent survey.
The survey results and the benefits of value-based design were recently discussed in an educational session at the AMCP meeting. Cynthia Nayer of the Center for Health Value Innovation and Michael Jacobs of Buck Consultants led the presentation.

The Center for Health Value Innovation just released the Value-Based Design 2009 Survey Report, which offers a comprehensive review of the opinions of >100 companies representing >1 million employees.

Value-based design is a sustainable method for both small and large employers and focuses on outcomes. It is used as an engagement tool to connect employees, employers, and healthcare providers to programs that use incentives and services to change behavior. These behavior changes can improve overall health and often drive the total value of health. Ms. Nayer said the dividends of value-based design programs also include increased performance and productivity, improved quality, and a reduction in costs.

The percentage of employers who are using incentives to promote behavioral change has grown considerably in recent years for large employers (19% in 2006 vs 26% in 2008) and jumbo employers serving ≥20,000 health plan members (32% in 2006 vs 45% in 2008).

According to information in the presentation, value-based designs only succeed when there is a primary focus on prevention and wellness and there are high levels of communication about the programs.

The Center for Health Value Innovation’s latest survey evaluated the opinions and practices of companies that had been using value-based designs for at least 2 years and found that 87% of those surveyed used performance levers in prevention and wellness. In addition, 60% used performance levers for chronic care management and 26% had levers in place to guide appropriate care delivery.
Despite the recent economic downturn, 79% of those questioned said they made no changes to their value-based design plan in 2009-2010 as a result of the economic concerns and 59% said there were no additional changes expected in the next plan year due to the economy.

The results also showed that most prevention and wellness plans (63%) had incorporated incentives for yearly screenings that waived cost sharing, paid the examination fee at 100% of the cost, or considered the examination outside the deductible. Insurance premiums were also waived for the completion of a Health Risk Assessment in 40% of the plans.

According to the survey results, 80% of those companies surveyed had care delivery programs that covered nurse practitioners and walk-in clinics. In addition, 70% waived copays for employees who used treatment sites with the lowest costs associated with them.

Companies promoted prevention and health through disease management programs (80%), plan participant education programs (78%), nurse hotlines (76%), financial incentives (69%), and an employee assistance program hotline (69%).

In addition, most care management programs covered chronic conditions such as diabetes (88%), asthma (81%), hypertension (77%), high cholesterol (65%), employee-assistance program issues (58%), and depression (54%).

To track the success and trends of the value-based designs, 70% of those surveyed reported using medical and pharmacy claims data. Other methods of trend analysis were disability claims data, workers’ compensation claims data, behavioral health claims data, or a combination of data types.
The survey also found that communication was key to behavior change and reported that 69% of companies communicated with their employees at least once a quarter. In addition, most companies used different forms of media to deliver their message, including company Web sites, e-mails, newsletters, workshops, and posters.

Although most companies communicated their message each quarter, 53% still felt they could have had better employee communication and engagement. According to the survey, 36% of those surveyed also felt they could have involved physicians, pharmacists, and clinicians in the process more and could have communicated with them more effectively.

According to the session’s presenters, patient care is improved through continuous quality improvement that assesses quality-related events and process breakdowns and then uses that information to develop improvement plans.

They believe that prevention is a good investment, even in difficult financial times, and said health savings accounts and health reimbursement accounts are the fastest growing segment in the healthcare marketplace. Removing barriers to treatment will improve the return on investment. Finally, value-based designs are an effective way to reduce waste and increase engagement.—Jill Sederstrom